Instrumental LessonApplication Form(Parent Billing)

This form is to apply for instrumental lessons either at a Music Centre or at your school.

Please return this form by post or email and the Music Centre will contact you to arrange the details.

Once tuition is confirmed, please note that this form constitutes a rolling contract which is only cancelled once notice has been given in writing in accordance with our Terms and Conditions.

Personal details
Student’s surname: / Forename:
Date of Birth: / Instrument(s):
Age: / Gender:
School: / Year of study as of September 2017:
Home address:
Postcode: / Home phone:
Parent Title: / Surname / Forename:
Parent email(s):
Student email:
Parent mobile number (emergency contact): / Student mobile:
Medical/Dietary/Learning needs:
Lesson details:
Location (name your school or music centre)
Instrument: / Level / Grade:
Choose one of the following options:
*Group lessons are organised through discussion with BLTM and are available where there are sufficient numbers of students of the same ability on the same instrument. A group may be 2-3 students or 4-6 students and rates differ accordingly. Group tuition is not available to students above grade 2 standard.
*For individual lessons of over 30 minutes, please speak to your Music Centre directly who will be able to advise further
Individual lesson** (30 mins):
Individual lesson (20 mins): / I am interested in a group lesson (4-6 students) as part of a Music Centre membership ☐
Group lesson* (if available):
Musical background:
Please complete if you are already engaged in some musical activity
Current teacher: / Level / Grade:
Have you had any Whole Class Instrumental Teaching at your school:
If YES, then please say which instrument:
List any other musical activities you have done:

Tuition terms and conditions

Please read these carefully and sign the statement to confirm your application.

Tuition is provided on an ongoing, rolling contract and pupils may only withdraw from activities at the end of a term following receipt of written notice to the Music Centre at least one half-termin advance to avoid fees being charged in lieu of notice. If late notice is received, parents will be invoiced for the following half-term.
Fees are invoiced termly and should be paid on receipt of invoice by cheque (payable to Buckinghamshire Learning Trust) or by bank transfer to:
Account name: Buckinghamshire Learning Trust
Sort code: 30 – 90 – 38
Account number: 53076868
You must ensure that you use the invoice number (starting with 4) as a payment reference
Parents are asked to inform the tutor of any known absences a minimum of one week in advance via the purple practice diary so that, where possible, these can be re-arranged within the same term. In the case of pupil absence, we are unable to reschedule lessons other than at the tutor’s discretion. Where the tutor is absent, parents will be informed via your child’s school and lessons will be rescheduled by the tutor in agreement with the school. Where the tutor is absent for more than one week, BLTM will endeavour to cover these lessons with an alternative tutor or will provide a refund at the end of the year for any sessions missed through tutor sickness.
We are committed to ensuring that all Music Centre activities are accessible to all young people and provide subsidies for families who are eligible for Free School Meals and for siblings of existing members. We are always willing to consider individual situations to ensure that any financial barriers to participation can be overcome and any parent may contact the Music Service and request to discuss with the Director at any time.
The Music Service is responsible for the safety of students whilst they are within the music centre or on a pre-arranged visit or performance off-site and has appropriate Risk Assessment, Safeguarding, Health & Safety and First Aid procedures in place. Parents must be responsible for their child’s safety and well-being at all other times, with particular regard to their journey to and from the music centres.
Please ensure that you inform the Music Centre directly if any of your personal details change, in particular phone and email contacts, including those named as emergency contacts.
Parents are responsible for ensuring that the Music Service is aware of any medical needs and special educational needs in regard to their child. Please ensure to complete the relevant section of the form is filled in and where necessary provide the relevant Area Leader with any further information.
The Music Service occasionally takes photos and audio/video recordings of pupils for archive purposes, teacher training and use in our own promotional material and publicity. If you do not wish your child to have their image used in this way please write NO in the box. For anything used by external agencies such as press, specific additional permission will be sought.
The Music Service would like to add your details to the Friends mailing list for your chosen centre. Please write NO in the box if you do not wish us to do so.
The Music Service as part of the Buckinghamshire Learning Trust is registered with the Data Protection Registrar’s Office and will not use or share this information outside the organisation without the express permission of the parent concerned.
I have read and accept these terms and conditions and would like to register my child at my chosen Music Centre as part of Buckinghamshire Learning Trust Music Service / Parent signature
(if by email then typed name confirms acceptance) / Date

Schools should return all completed forms to their local Area Music Centre as follows:

Amersham Music Centre,Amersham School, Stanley Hill, Amersham, Bucks, HP7 9HH

Aylesbury Music Centre, Walton Road, Aylesbury, Buckinghamshire, HP21 7ST

High Wycombe Music Centre, Mill End Road, High Wycombe, Buckinghamshire, HP12 4BA